These are my thoughts as I prepare for the What’s Next Boomer Business Summit and American Society on Aging conference in San Diego next week. Since I am also attending the National Forum on Aging in Community I reviewed the current issue of Generations Journal focused on that topic. Aging in Place has changed since I got hooked over 20 years ago. Is the change reflected in the debate about whether it should be Aging in Place or aging in Community? I agree that Aging in Community is right but that doesn’t make Aging in Place wrong. It is not the conceptual view of breadth or where that has changed. The change that impresses me most is the wider range of stakeholders and their interests than even a few years ago.
When I got started the justification for Aging in Place was preference. The early 90’s saw the first of many AARP and other studies showing that 80+% of adults wanted to remain in their own home even if they needed assistance. As the movement for respect in serving older adults emerged (see Betty Friedan, The Fountain of Age) and providers began to recognize the private pay/better service market, the idea of meeting a “customer’s” interests gained ground. Serving seniors in a business-like model rather than a social work model was a brand new notion. Encore careers, villages, NORCs, consumer direction, self management, multi-generation and other recognized, progressive ideas were not part of the discussion. High tech monitoring and on-line portals and management were not considerations.
There was little talk about the financial benefits of Aging in Place. There was a hint, but no evidence, and not very much interest. This is a big change. Readmission penalties and the accountable care act are brand new. New stakeholders with significant financial interest – hospital systems and health payers, and all those with more or less clout but who may save or profit from Aging in Community – are now part of the equation. Is Aging in Place a better use of human, medical and economic resources? Evidence is mounting. My prediction is that what has been a secondary consideration will soon be at the forefront. Why? Because stakeholders with more money to win or lose and the power and experience to influence are taking an interest.
The result will be encouragements and incentives – pushes. There will be lots of approaches: premium breaks for those who prepare their homes or take fall prevention measures, subsidies for home modifications and universal design, home safety job programs, partnerships among monitoring companies and health providers. Think about seatbelts. Was it safety or health costs? How did complaining about the cost of seat belts and air bags morph into requirements that they be installed and used? Similar scenarios are Aging in Place’s future.
BUT what is missing from the discussion? Attention and improvement to the HCBS or LTSS* provider networks. They are assumed. Never a good idea to assume. We will soon be building a data driven coordinated system for managing care in individual homes. The new system will use parts of the current system in ways that resemble the shift from neighborhood bookstores to Amazon.com. Attention is just starting. This new frontier -systematic business models for currently loosely networked in home providers- will grow to meet consumer and wide ranging stakeholder demand for Aging in Community.
It is a shift. It requires innovation. It is exciting. Like many business revolutions it will unfold almost in the background as a new reality takes hold. Get ready for change. You rarely see it coming.
* Home and Community Based Services or Long Term Service and Supports
Louis Tenenbaum, one of the nation's leading authorities on aging in place, is the founder of HomesRenewed, a coalition of business, consumers and nonprofits, driving policy and investment to increase the number of age-friendly homes.